Theme: Epidemiology & Public Health Research Year: 2024
Background: Closures or reduced healthcare services such as harm reduction services and hepatitis C virus (HCV)/HIV testing and treatment during the COVID-19 pandemic, as well as pandemic mitigation measures like social distancing and stay-at-home orders, may have disproportionally impacted vulnerable groups such as people who inject drugs (PWID). Understanding how the COVID-19 pandemic impacted behaviors and subsequently changed the trajectory of HCV and HIV is key to estimating disease burdens, identifying outbreak risk, and developing more informed intervention strategies.
Methods: Using behavioral data (2014-2023) from 1707 participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, an ongoing community-based cohort of PWID in Baltimore, USA, and an individual-based network model, we explored the impact of reported service disruptions combined with changes in social and injecting behaviors on HCV and HIV transmission from years 2018 to 2028.
Results: During the pandemic, PWID were overall 62% less likely to inject drugs, but those who continued injecting increased their frequency by 44%. The overall number of drug use partnerships reduced from 3 to 1 and the probability of injecting with a partner decreased by 27% (all p-values < 0.01). Our simulation results demonstrated that service disruptions alone resulted in 6.0% and 1.1% relative increase in HCV and HIV prevalence (both p-values < 0.05) with disruptions to syringe service programs having the largest individual impact. In contrast, HCV and HIV burdens were respectively lowered by 6.1% and 3.5% relative to baseline (both p-values < 0.01) when including the observed behavior changes on top of service disruptions.
Conclusion: Despite limitations due to potential informative losses, model results combined with rich individual behavioral data indicated that pandemic-induced changes in social and injecting behaviors of PWID can offset the increased HCV and HIV burden by service disruptions.
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